What are the common symptoms of a nonviable pregnancy?

Typical signs include heavy vaginal bleeding, severe abdominal cramps, a fetal heartbeat in early scans, or halted embryonic growth. However, some nonviable pregnancies may be asymptomatic and only detected during routine check-ups.

Can I have a healthy pregnancy after experiencing a nonviable one?

Absolutely. Many women go on to have healthy pregnancies after a nonviable one. With proper medical care, lifestyle adjustments, and emotional support, future pregnancies can be both viable and fulfilling.

Viable vs Nonviable Pregnancy: Causes, Signs & What You Need to Know

What is a viable pregnancy, and what does it mean?

The answer is yes; a pregnancy can be nonviable without symptoms. These are just some of the many questions expectant parents have when responding to uncertainty in the early days of pregnancy. Understanding the difference between a viable pregnancy and a non-viable one can be complex and overwhelming, but it is crucial to understand to make informed decisions. Take a deep dive into your most pressing concerns. Understanding the definitions, diagnostic criteria, and associated outcomes of viable and nonviable pregnancies establishes a framework for navigating this intensely personal and, at times, emotionally fraught experience.

What is a Viable Pregnancy?

A viable pregnancy is when the foetus is developing normally and is expected to survive both within the uterus and outside of the womb after a certain gestational age. Viability is assessed in clinical practice with an ultrasound scan that confirms foetal heart rate and appropriate growth patterns.Viability typically occurs when a foetus reaches a gestational age of 22 to 24 weeks, though survival rates increase significantly after the 28th week. Until this threshold, the possibility of the foetus surviving without serious medical complications is reduced. Additional normal findings include increasing human chorionic gonadotropin (hCG) levels, normal foetal movements, and a well-developed placenta and amniotic environment.

The Role of Progesterone in Early Pregnancy

Progesterone, a hormone that is important for preparing the uterus for implantation and maintaining a healthy pregnancy, is critical in the first trimester. Low progesterone levels have been linked to a higher risk of miscarriage. Progesterone is supplemented in early pregnancy (by oral, vaginal, and injectable means) under some conditions, particularly with patients with recurrent losses or luteal phase defects. However, its effectiveness is contingent upon the cause and should be guided by medical evaluation.

What is a Nonviable Pregnancy?

A nonviable pregnancy is any pregnancy that cannot advance to the stage at which the foetus can survive outside the womb. A broad range of complications or abnormalities can lead to this. There are many types of nonviable pregnancies, some of which include:

An ectopic pregnancy, in which the fertilised egg implants itself elsewhere in the body, usually in a fallopian tube.
Blighted ovum (also called an anembryonic pregnancy), where a gestational sac forms but no embryo develops.
In molar pregnancy, abnormal trophoblastic tissue proliferates instead of normal embryonic tissue.
Foetal demise is when a foetus that previously displayed signs of life no longer has a heartbeat.
High risk of severe congenital malformations that are incompatible with life (e.g. anencephaly, some chromosomal defects).

In these scenarios, the foetus is either nonviable from the start or becomes nonviable throughout gestation.

Causes of Nonviable Pregnancies

There are many reasons a pregnancy can become nonviable. Some of its causes are known and preventable; others arise spontaneously from genetic or physiological errors.

Chromosomal abnormalities: Chromosomal abnormalities are the most common cause of early pregnancy loss, accounting for almost half of all cases. Such errors often happen before implantation, when the egg and sperm connect with the wrong number of chromosomes. The resulting embryo can’t grow properly, resulting in a miscarriage, typically in the first trimester.
Abnormalities in the uterus or tubes: Structural or functional disorders in the reproductive tract can lead to a nonviable pregnancy. Injuries or defects in the fallopian tubes, which are most often caused by infections, endometriosis or previous pelvic surgeries, can either prevent proper implantation or raise the risk of ectopic pregnancies. Abnormalities in the uterus, like fibroids or a septate uterus, can also interfere with embryo growth.
Molar pregnancies and abnormal fertilisation: If the pregnancy is molar, meaning the egg is fertilised with 2 sperm, the embryo fails to form, but the tissue does.

Molar pregnancies happen when fertilisation goes wrong.

A molar pregnancy is where there is no embryo, just abnormal growth of tissue.
A partial molar pregnancy might have a malformed embryo that can’t survive.

Both are types of nonviable pregnancies that require medical intervention.

Blighted ovum (Anembryonic pregnancy): A blighted ovum is when an embryo fails to develop after fertilisation, but the gestational sac persists in developing. Often, the result of chromosomal problems can go undetected until a routine scan, since early pregnancy signs can remain.
Hormonal and autoimmune disorders: Low progesterone levels, which are needed to maintain the uterine lining and support early pregnancy, can raise the odds of miscarriage. Autoimmune disorders such as antiphospholipid syndrome can also inhibit the implantation of embryo development through abnormal blood clotting, causing recurrent pregnancy loss (RPL) if untreated. RPL means that when a woman has two or more pregnancy losses in a row, she is often offered thorough medical treatment. Potential causes include:

Hormonal or metabolic imbalances: Disorders such as thyroid dysfunction, polycystic ovary syndrome (PCOS), or poorly controlled diabetes can impact the viability of a pregnancy.
Genetic factors: Parental chromosomal abnormalities (e.g., balanced translocations).
Uterine anomalies: Issues such as a septate uterus or fibroids that can be congenital or acquired.
Immunological factors: Antiphospholipid syndrome (APS) is an autoimmune disease that has been shown to increase the likelihood of clotting.

Tests may include thyroid function tests, karyotyping, uterine imaging and screening for autoimmune or clotting disorders.

Infections: Some infections are directly dangerous to the viability of the pregnancy. Infection with pathogens like Listeria (often found in unpasteurised dairy), Toxoplasma gondii (from undercooked meat or cat litter), rubella or cytomegalovirus can endanger the developing embryo and cause it to miscarry. Most of these risks can be reduced through safe food handling, hygiene and vaccination whenever indicated.
Factors related to lifestyle and medical conditions: Lifestyle choices and other poorly managed health conditions can also be factors.

Smoking, drinking and drugs raise the risk of miscarriage and foetal defects.
Uncontrolled diabetes or thyroid disorders can disturb the hormonal milieu and the uterine environment, making the continuation of pregnancy difficult.

Importance of Mental Health Support

The emotional toll of pregnancy loss, particularly multiple losses, can be heavy. Depression, anxiety, and grief are common, and taking care of mental health is vital for overall health. Options include:

Therapies and counselling: A psychologist or licensed therapist can help you through your grief and trauma.
Support groups: Peer-led groups or online forums can offer a space to share and connect with others facing similar challenges.
Medication: When facing clinical anxiety or depression, psychiatric medication may be necessary and can be safely managed in consultation with your healthcare team in subsequent pregnancies.

A healthy response to trauma and grief is to seek help, and this is extremely encouraged.

Signs and Symptoms of a Non-Viable Pregnancy

Identifying the symptoms of a nonviable pregnancy at an early stage is key to receiving timely medical attention and additional support. Some cases are asymptomatic until a routine ultrasound, while others come with telltale physical and emotional signs.The most frequent symptoms are vaginal bleeding, which can be light spotting or heavier flow with clots. Bleeding may be accompanied by cramping or abdominal pain, often like menstrual cramps. A sudden loss of pregnancy symptoms like breast tenderness, nausea or fatigue can also be a sign, but not always.In certain cases, a lack of foetal heartbeat or an empty gestational sac on an ultrasound can confirm the diagnosis. It’s important to understand that these symptoms can also be present in healthy pregnancies, so a medical evaluation is the only way to know what is or isn’t viable.If any of these symptoms develop, contact your healthcare professional immediately for evaluation and advice.

Diagnosis of Viable vs Nonviable Pregnancy

Determining whether a pregnancy is viable or nonviable requires clinical tools and medical judgment. The most common methods of diagnosis include:

Ultrasound: Vaginal or abdominal ultrasound is performed to determine gestational age, the size of the embryo or foetus, identify a heartbeat, and the general growth of the foetus. A heartbeat can typically be detected between six and seven weeks of gestation. If there is no fetal heart rate (FHR) when CRL is greater than (>) 7 mm, a nonviable pregnancy is likely.
Importance of hCG levels: hCG blood tests are typically performed in early pregnancy. In a normal pregnancy, hCG numbers will double every 48–72 hours. An hCG plateau or decline may hint at a nonviable pregnancy.
Pelvic exam: This may help detect ectopic pregnancies or physical signs of miscarriage, like cervical dilation or bleeding.

For borderline cases, the final diagnosis can take several days and may depend on repeat tests and imaging.

Emotional and Psychological Impact of a Nonviable Pregnancy

The emotional burden of learning that you have a nonviable pregnancy can be crushing. The loss of an expected child, whether it occurs early in pregnancy or later, is a personal and complex grief.Suffering from grief, anger, confusion, and guilt, many people blame themselves for the outcome when it is not in their power. For others, the experience can lead to depression, anxiety or even symptoms of post-traumatic stress disorder (PTSD).Partners often grieve differently, which can lead to an emotional chasm or even misunderstanding in the relationship. Support is critical, from friends and family, health care professionals, and support groups.Counselling can also provide a safe space to begin processing emotions, grieving, and rebuilding one's life.

Medical Interventions for Nonviable Pregnancies

Once a nonviable pregnancy has been confirmed, medical treatment may also be necessary to help safely manage the situation. Options include:

Management of miscarriage: Expectant management entails abstaining and allowing the body to pass (miscarry) independently. In early foetal demise and blighted ovum cases, it can be advised. While it avoids medical interventions, the process can be long, emotionally and physically.
Medications: Medications like misoprostol and mifepristone can be prescribed to induce uterine contractions and expel pregnancy tissue. This is an option in cases of early miscarriages.
Surgical management: Procedures like dilation and curettage (D&C) or manual vacuum aspiration (MVA) are done to remove the pregnancy tissue if indicated. These options are usually suggested later in a nonviable pregnancy or when complications such as heavy bleeding arise.

Choosing a method often depends on a person’s health, personal preference, gestational age and medical advice.

Preventing Nonviable Pregnancies

Not all nonviable pregnancies can be prevented, but some measures can lessen the likelihood of having one:

Healthy lifestyle choices: Steer clear of alcohol, tobacco and recreational drugs. Follow a balanced diet and maintain a healthy weight while staying physically active if your healthcare professional advises.
Control pre-existing health conditions: Pre-existing conditions must be optimally managed before and during pregnancy, including diabetes, hypertension and thyroid disorders.
Regular prenatal care: Regular check-ups in the early stages can help track the foetus's development and detect complications, if any, at an earlier stage.
Genetic counselling: Genetic screening and counselling before conception may be helpful for couples who have a history of pregnancy loss or pre-existing genetic disorders.
Stay away from harmful chemicals: Avoid exposure to toxins, from pesticides and radiation to environmental pollutants.
Explore medical intervention for recurrent pregnancy loss: For those with repeated losses, healthcare professionals may recommend supplementing with the hormone progesterone in early pregnancy to support the uterine lining or low-dose aspirin to enhance blood flow in certain circumstances, such as antiphospholipid syndrome. Some medical treatments for RPL are:

For antiphospholipid syndrome, treatment typically involves low-dose aspirin and heparin to prevent clot formation and support placental function.
In luteal phase defects, progesterone may be used.
If uterine anomalies (such as a septum) are surgically corrected, the risk of future loss may be reduced.
In cases of unexplained RPL, emerging therapies with IVIG or immunotherapy may be considered under the guidance of specialists, though the evidence is still evolving.

Although these may not guarantee a successful pregnancy, they enhance overall reproductive health and minimise risks.Pregnancy can be a journey in so many directions, some joyful, some with loss. Understanding how a pregnancy can exist allows people to confront reality clearly and kindly. Medical science provides the support people need, but emotional resilience and guidance are equally crucial. As with all pregnancy experiences, whether they bring new life or loss, this experience should be recognised with empathy. If you or a loved one finds themselves in such a place, know that healing is possible. With proper care and nurturing, there’s always room for hope, strength and a brighter tomorrow.

FAQs on Viable Pregnancy and Nonviable Pregnancy: Here's All You Need To Know

What are the common symptoms of a nonviable pregnancy?Typical signs include heavy vaginal bleeding, severe abdominal cramps, a fetal heartbeat in early scans, or halted embryonic growth. However, some nonviable pregnancies may be asymptomatic and only detected during routine check-ups.
Can I have a healthy pregnancy after experiencing a nonviable one?Absolutely. Many women go on to have healthy pregnancies after a nonviable one. With proper medical care, lifestyle adjustments, and emotional support, future pregnancies can be both viable and fulfilling.

Viable Pregnancy and a Nonviable Pregnancy: Here's All You Need To Know

In this article: